Provider Demographics
NPI:1174958003
Name:MCKENNA, LAURA
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 W ATLANTIC AVE
Mailing Address - Street 2:STE D104
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445
Mailing Address - Country:US
Mailing Address - Phone:561-499-7933
Mailing Address - Fax:561-499-7949
Practice Address - Street 1:2605 W ATLANTIC AVE
Practice Address - Street 2:STE D104
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4414
Practice Address - Country:US
Practice Address - Phone:561-499-7933
Practice Address - Fax:561-499-7949
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9287318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily